| NPI | 1578192795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 33113501) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MO 2022041194) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: TX V0185) | |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2022041194) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX V0185) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NY 33113501) | |
| Enumeration Date | 2020-04-08 |
| Last Update Date | 2025-10-07 |