| NPI | 1093058604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: UT 12931506-1204) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: UT 12931506-1204) |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: UT 12931506-1204) | |
| Enumeration Date | 2013-04-02 |
| Last Update Date | 2024-08-16 |