| NPI | 1346532587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX P6406) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX P6406) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: TX P6406) | |
| Enumeration Date | 2011-05-06 |
| Last Update Date | 2020-01-25 |