| NPI | 1790096980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: KY TP325) |
| Additional Taxonomies | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: IN 01075440A) |
| Enumeration Date | 2010-06-23 |
| Last Update Date | 2025-08-28 |