| NPI | 1316248503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P6221) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: TX P6221) |
| 208VP0000X Pain Medicine Pain Medicine (Licence: TX P6221) | |
| Enumeration Date | 2010-11-04 |
| Last Update Date | 2024-12-06 |