| NPI | 1083653513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX M2907) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: TX M2907) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX M2907) | |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2022-08-18 |