| NPI | 1992329007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: NC 328794) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: CT 84577) |
| Enumeration Date | 2020-06-04 |
| Last Update Date | 2026-07-14 |