| NPI | 1366860991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: TX S2329) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX S2329) |
| 207LP2900X Anesthesiology Pain Medicine (Licence: TX S2329) | |
| Enumeration Date | 2014-04-01 |
| Last Update Date | 2024-09-24 |