| NPI | 1316087372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: UT 74518491205) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: UT 74518491205) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2022-02-23 |