| NPI | 1811429756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: KY 55460) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KY R4374) |
| 207L00000X Anesthesiology (Licence: KY 55460) | |
| Enumeration Date | 2017-03-30 |
| Last Update Date | 2022-07-26 |