| NPI | 1255795597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: TX T1137) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 271677) |
| Enumeration Date | 2016-04-13 |
| Last Update Date | 2021-07-12 |