| NPI | 1407827918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: TX N1472) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX N1472) |
| 208D00000X General Practice (Licence: VA 0101232625) | |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2020-09-15 |