| NPI | 1780114975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: GA 92204) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: GA 92204) |
| 207L00000X Anesthesiology (Licence: MA 271781) | |
| 207L00000X Anesthesiology (Licence: IL 125071636) | |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2025-10-31 |