| NPI | 1679572994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX L0314) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX L0314) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: TX L0314) | |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2021-06-14 |