| NPI | 1760979983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: SC 89723) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL OS18687) |
| Enumeration Date | 2018-04-13 |
| Last Update Date | 2024-03-13 |