| NPI | 1063413193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX M6176) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: TX M6176) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2024-11-13 |