| NPI | 1881634368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: KY 28741) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: KY 28741) |
| 207L00000X Anesthesiology (Licence: KY 28741) | |
| 2084A0401X Psychiatry & Neurology, Addiction Medicine (Licence: KY 28741) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: KY 28741) | |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2021-12-16 |