| NPI | 1104142397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX q1532) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX BP10036850) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX Q1532) | |
| Enumeration Date | 2010-04-13 |
| Last Update Date | 2025-08-07 |