| NPI | 1295784676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: TX K5596) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX K5596) |
| 207L00000X Anesthesiology (Licence: TX K5596) | |
| 207Q00000X Family Medicine (Licence: CO 39260) | |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2020-09-30 |