| NPI | 1740540814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: TX Q9253) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX BP10043700) |
| 207LP2900X Anesthesiology Pain Medicine (Licence: TX Q9253) | |
| Enumeration Date | 2012-05-23 |
| Last Update Date | 2025-04-29 |