| NPI | 1104852888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX G0020) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX G0020) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2026-04-30 |