| NPI | 1063894541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: OR MD198577) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: WA MD61059947) |
| 2084P2900X Psychiatry & Neurology Pain Medicine (Licence: OR MD198577) | |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2022-05-19 |