| NPI | 1609024371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: TX N0930) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX N0930) |
| 207LP2900X Anesthesiology Pain Medicine (Licence: TX N0930) | |
| Enumeration Date | 2008-09-05 |
| Last Update Date | 2023-11-03 |