| NPI | 1669887311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: TX S1493) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 274972) |
| Enumeration Date | 2014-06-20 |
| Last Update Date | 2024-03-06 |