| NPI | 1750849402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: UT 13891956-1205) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MN 69916) |
| Enumeration Date | 2019-03-12 |
| Last Update Date | 2024-03-29 |