| NPI | 1902078298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: OK 24593) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: OK 24593) |
| 207QS0010X Family Medicine, Sports Medicine (Licence: TX N4691) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX N4691) | |
| Enumeration Date | 2008-03-27 |
| Last Update Date | 2023-01-26 |