| NPI | 1235579731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: UT 5495552-1205) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: UT 5495552-1205) |
| Enumeration Date | 2013-06-28 |
| Last Update Date | 2023-03-29 |