| NPI | 1780118737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MI 4301510315) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: MI 4301510315) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MI 4301510315) | |
| 207L00000X Anesthesiology (Licence: MI 4301510315) | |
| 208VP0000X (Licence: MI 4301510315) | |
| Enumeration Date | 2017-04-17 |
| Last Update Date | 2026-03-27 |