| NPI | 1821048513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: KY 35219) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KY 35219) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: KY 35219) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: IN 01047434A) | |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2023-12-06 |