| NPI | 1942524806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: TX Q3439) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX Q3439) |
| 207L00000X Anesthesiology (Licence: TX Q3439) | |
| 207LP2900X Anesthesiology Pain Medicine (Licence: TX Q3439) | |
| Enumeration Date | 2010-03-22 |
| Last Update Date | 2021-06-15 |