| NPI | 1942367156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL ME69424) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: NC 20010673) |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2025-03-21 |