| NPI | 1699069104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX q7519) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: TX Q7519) |
| 208VP0000X (Licence: CO DR.74599) | |
| Enumeration Date | 2011-06-01 |
| Last Update Date | 2025-04-03 |