| 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 |