| NPI | 1972941904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX R7157) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX R7157) |
| Enumeration Date | 2013-06-12 |
| Last Update Date | 2022-12-19 |