| NPI | 1003805946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: TX H5595) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX H5595) |
| 207LP2900X Anesthesiology Pain Medicine (Licence: TX H5595) | |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2023-01-16 |