| NPI | 1366184178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX W7737) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX W7737) |
| Enumeration Date | 2022-04-12 |
| Last Update Date | 2026-08-05 |