| NPI | 1124689195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX V0353) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX V0353) |
| Enumeration Date | 2019-06-21 |
| Last Update Date | 2026-02-20 |