| NPI | 1831620319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine (Licence: KY 05038) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KY 05038) |
| Enumeration Date | 2017-03-25 |
| Last Update Date | 2022-08-15 |