| NPI | 1235220468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: TX H2154) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX H2154) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX H2154) | |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2023-03-30 |