| NPI | 1821482993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: TX S3369) |
| Additional Taxonomies | 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: TX S3369) |
| Enumeration Date | 2015-03-26 |
| Last Update Date | 2022-10-14 |