| NPI | 1801126735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: TX S4421) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 47460) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX S4421) | |
| Enumeration Date | 2009-12-24 |
| Last Update Date | 2025-11-12 |