| NPI | 1609875970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X (Licence: TX G5417) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: TX G5417) |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2022-05-19 |