| NPI | 1942861638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: TX T0993) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX T0993) |
| Enumeration Date | 2019-06-24 |
| Last Update Date | 2024-08-30 |