| NPI | 1336397280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX P0257) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: TX P0257) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL ME111197) | |
| Enumeration Date | 2008-09-04 |
| Last Update Date | 2020-01-19 |