| NPI | 1376556456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX G8557) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: TX G8557) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: TX G8667) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: TX G8557) | |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2024-10-14 |