| NPI | 1174542286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX M3802) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: TX M3802) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: GA 93436) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2023-08-01 |