| NPI | 1750308664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NC 200201393) |
| Additional Taxonomies | 207LA0401X Anesthesiology, Addiction Medicine (Licence: NC 2002-01393) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: NC 200201393) | |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2025-11-20 |