| NPI | 1760878953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL ME162184) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: AR E-12351) |
| Enumeration Date | 2015-04-14 |
| Last Update Date | 2023-08-15 |