| NPI | 1770847154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: MS 24480) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MS 24480) |
| 207L00000X Anesthesiology (Licence: TN 56573) | |
| 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: TN 56573) | |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: TN 56573) | |
| Enumeration Date | 2012-06-29 |
| Last Update Date | 2022-05-07 |