| NPI | 1861636847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: TX P0954) |
| Additional Taxonomies | 208D00000X General Practice (Licence: TX P0954) |
| 1223G0001X Dentist, General Practice (Licence: TX 31221) | |
| Enumeration Date | 2009-04-22 |
| Last Update Date | 2024-10-29 |