| NPI | 1740387612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD60339715) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: AK 5951) |
| 207L00000X Anesthesiology (Licence: TX P3757) | |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: WA MD60339715) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: AK 5951) | |
| 207Q00000X Family Medicine (Licence: AK 5951) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: TX P3757) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2023-11-02 |