| NPI | 1154561090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: UT 5683078-1205) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: UT 5683078-1205) |
| Enumeration Date | 2009-03-05 |
| Last Update Date | 2025-03-14 |