| NPI | 1346235355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: NV 6038) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: AZ 30928) |
| 207L00000X Anesthesiology (Licence: NV 6038) | |
| 207L00000X Anesthesiology (Licence: TX H2015) | |
| 207L00000X Anesthesiology (Licence: UT 5888603-1205) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: AZ 30928) | |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2022-01-27 |