| NPI | 1790125805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: AL MD.43394) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: AL MD.43394) |
| 207L00000X Anesthesiology (Licence: MS T-2730) | |
| Enumeration Date | 2013-07-03 |
| Last Update Date | 2023-11-10 |