| NPI | 1114918265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X (Licence: TX M4132) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: IA 35326) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX M4132) | |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: TX M4132) | |
| 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: TX M4132) | |
| Enumeration Date | 2005-10-28 |
| Last Update Date | 2026-07-15 |