| NPI | 1861562407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX L1048) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: TX L1048) |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: TX L1048) | |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2024-10-03 |