| NPI | 1720119415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: TX J1161) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: MO 101972) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX J1161) | |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2013-01-24 |