| NPI | 1871970871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NY 298990) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX S6098) |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: TX S6098) | |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2023-02-22 |