| NPI | 1568643120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: CO 53756) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: MI EMC0007407) |
| 207L00000X Anesthesiology (Licence: TX M7857) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX M7857) | |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: VA 0101248997) | |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: TX M7857) | |
| Enumeration Date | 2007-11-23 |
| Last Update Date | 2025-09-10 |