| NPI | 1104037878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: UT 7514078-1205) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: IA R7512) |
| 207LP2900X Anesthesiology Pain Medicine (Licence: TX BP10033560) | |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2015-02-04 |