| NPI | 1053355321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2083A0300X Preventive Medicine, Addiction Medicine (Licence: TX L2672) |
| Additional Taxonomies | 207LA0401X Anesthesiology, Addiction Medicine (Licence: TX L2672) |
| 207L00000X Anesthesiology (Licence: TX L2672) | |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: TX L2672) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: TX L2672) | |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2026-01-22 |