| NPI | 1962661488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2083A0300X Preventive Medicine Addiction Medicine (Licence: KY 46107) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: KY 46107) |
| 208D00000X General Practice (Licence: KY 46107) | |
| 208VP0000X Pain Medicine Pain Medicine (Licence: KY 46107) | |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: IN 01072910A) | |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2024-04-12 |