NPI | 1386636272 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: WI 59956) |
Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: TX N6870) |
207Q00000X Family Medicine (Licence: WI 59956) | |
207Q00000X Family Medicine (Licence: TX N6870) | |
Enumeration Date | 2005-08-17 |
Last Update Date | 2013-09-26 |