| NPI | 1619932761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: UT 6353467-1205) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 48296) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2022-02-15 |