| NPI | 1235136607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: TX 36044) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX K2865) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX 08905) | |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2012-10-03 |