| NPI | 1407054711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: NE 31875) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NM PA2003-0016) |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: NE 31875) | |
| Enumeration Date | 2007-07-07 |
| Last Update Date | 2020-11-18 |