| NPI | 1679885693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: TX R3401) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 253980) |
| 207L00000X Anesthesiology (Licence: MA L-244758) | |
| 207LP2900X Anesthesiology Pain Medicine (Licence: TX R3401) | |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: MA 253980) | |
| Enumeration Date | 2010-07-07 |
| Last Update Date | 2021-01-18 |