| NPI | 1992805410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: KY 29929) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: KY 29929) |
| Enumeration Date | 2006-09-24 |
| Last Update Date | 2023-02-27 |