| NPI | 1760832828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: AZ 63778) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 268113) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: AZ 63778) | |
| Enumeration Date | 2016-06-20 |
| Last Update Date | 2023-02-14 |