| NPI | 1811128887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: TX R0484) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: IA MD-41922) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: IA MD-41922) | |
| Enumeration Date | 2009-08-07 |
| Last Update Date | 2017-04-27 |