| NPI | 1336150945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX H9876) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX H9876) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: TX H9876) | |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2008-07-01 |