| NPI | 1003885831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: TX S6593) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX S6593) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX S6593) | |
| Enumeration Date | 2006-03-15 |
| Last Update Date | 2024-01-02 |