| NPI | 1730113440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: TN 31387) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: TN MD31387) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2025-03-03 |