| NPI | 1558423038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: TX P6985) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA OT011399) |
| 207L00000X Anesthesiology (Licence: MA 238092) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX P6985) | |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2016-02-18 |