| NPI | 1972770386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: OK 29457) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX M8261) |
| Enumeration Date | 2008-05-14 |
| Last Update Date | 2024-04-15 |