| NPI | 1093920399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX N2767) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX N2767) |
| 208VP0000X Pain Medicine Pain Medicine (Licence: TX N2767) | |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: TX N2767) | |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2024-06-24 |