| NPI | 1093759995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P2900X Psychiatry & Neurology Pain Medicine (Licence: WA MD60545557) |
| Additional Taxonomies | 2084P2900X Psychiatry & Neurology Pain Medicine (Licence: PA MD418943) |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: WA MD60545557) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2023-02-15 |