| NPI | 1790880003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: PA MD436232) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: FL ME88789) |
| 174400000X Specialist (Licence: FL ME88789) | |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2025-10-14 |