| NPI | 1780147868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX U8736) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL ME151916) |
| Enumeration Date | 2019-04-07 |
| Last Update Date | 2024-12-13 |