| NPI | 1679774152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: TX M2282) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: TX M2282) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2023-01-11 |