| NPI | 1992965982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine (Licence: TX P3056) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX P3056) |
| 207L00000X Anesthesiology (Licence: NC 2013-01741) | |
| 207LP2900X Anesthesiology Pain Medicine (Licence: TX P3056) | |
| 208VP0000X Pain Medicine Pain Medicine (Licence: NC 2013-01741) | |
| Enumeration Date | 2008-06-12 |
| Last Update Date | 2021-07-08 |