| NPI | 1902269566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MO 2021013639) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KS 9408888) |
| Enumeration Date | 2016-03-31 |
| Last Update Date | 2022-07-05 |