| NPI | 1316943392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: TX M9757) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX M9757) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX M9757) | |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2020-01-06 |