| NPI | 1790075703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL ME128030) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD P26496) |
| 207L00000X Anesthesiology (Licence: AL MD.32030) | |
| Enumeration Date | 2011-04-11 |
| Last Update Date | 2022-09-28 |