| NPI | 1891795688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: MI 4301504095) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: TX S3178) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX S3178) | |
| Enumeration Date | 2005-07-22 |
| Last Update Date | 2022-03-17 |