| NPI | 1144751959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: TX T4451) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX T4451) |
| 207L00000X Anesthesiology (Licence: MD D99492) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX T4451) | |
| Enumeration Date | 2017-03-23 |
| Last Update Date | 2025-07-10 |