| NPI | 1518910769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: TX H6108) |
| Additional Taxonomies | 208VP0000X Pain Medicine Pain Medicine (Licence: TX H6108) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2023-10-17 |