| NPI | 1942291406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LA0401X Anesthesiology Addiction Medicine (Licence: TX 2015263) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: TX J0055) |
| 207LP2900X Anesthesiology Pain Medicine (Licence: TX J0055) | |
| Enumeration Date | 2005-11-03 |
| Last Update Date | 2018-03-19 |