| NPI | 1043297856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: TX K4130) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX K4130) |
| 207LP2900X Anesthesiology Pain Medicine (Licence: TX K4130) | |
| 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: TX K4130) | |
| 2084P2900X Psychiatry & Neurology Pain Medicine (Licence: TX K4130) | |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2024-05-15 |