| NPI | 1104001148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: TX P2850) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX P2850) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX P2850) | |
| Enumeration Date | 2008-01-09 |
| Last Update Date | 2023-12-05 |