| NPI | 1386636272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: WI 59956) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WI 59956) |
| 207Q00000X Family Medicine (Licence: TX N6870) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: WI 59956-21) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: TX N6870) | |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2024-11-14 |