| NPI | 1790701373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MI 4301075156) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4301075156) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: MI 4301075156) | |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2025-04-22 |