| NPI | 1952632143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX P7051) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX P7051) |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: TX P7051) | |
| Enumeration Date | 2010-01-27 |
| Last Update Date | 2025-08-13 |