| NPI | 1255339552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: UT 1835611205) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: UT 1835611205) |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2019-09-05 |