| NPI | 1992703805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X (Licence: DE C1-0010931) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MD D0063356) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: PA MD421194) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: DE C1-0010931) | |
| 207L00000X Anesthesiology (Licence: DE C1-0010931) | |
| 207L00000X Anesthesiology (Licence: PA MD421194) | |
| 208VP0000X (Licence: PA MD421194) | |
| 208VP0000X (Licence: MD D0063356) | |
| 207L00000X Anesthesiology (Licence: MD D0063356) | |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2025-07-18 |