| NPI | 1316924558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: CO 49168) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: TX M2814) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2024-01-10 |