| NPI | 1770102451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: MN 79178) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: IA MD-53065) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: IA MD-53065) | |
| Enumeration Date | 2020-04-13 |
| Last Update Date | 2025-07-23 |