| NPI | 1336137785 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX L9393)  | 
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX L9393)  | 
| Enumeration Date | 2005-10-10 | 
| Last Update Date | 2015-08-25 |