| NPI | 1174551923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: OK 24875) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OK 24875) |
| 207R00000X Internal Medicine (Licence: OK 24875) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: TX E6543) | |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2022-01-10 |