| NPI | 1790088508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: TX P2699) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX BPI0031946) |
| Enumeration Date | 2010-12-16 |
| Last Update Date | 2020-02-27 |