| NPI | 1932424751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine (Licence: TX Q4612) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: TX Q4612) |
| 207L00000X Anesthesiology (Licence: TX Q4612) | |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: TX Q4612) | |
| Enumeration Date | 2010-04-05 |
| Last Update Date | 2015-08-10 |