| NPI | 1861435364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: GA 63728) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: KY TP454) |
| 174400000X Specialist (Licence: LA 022356) | |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: GA 63728) | |
| 207L00000X Anesthesiology (Licence: KY TP454) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: KY TP454) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: GA 63728) | |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2026-04-29 |