| NPI | 1093705360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX F0412) |
| Additional Taxonomies | 208VP0000X Pain Medicine Pain Medicine (Licence: TX F0412) |
| Enumeration Date | 2005-10-26 |
| Last Update Date | 2022-09-29 |