| NPI | 1003909276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: CO 40977) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NM 2000325) |
| 204R00000X Electrodiagnostic Medicine (Licence: CO 40977) | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2012-11-16 |