| NPI | 1093973984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine (Licence: LA MD.04518R) |
| Additional Taxonomies | 208800000X Urology (Licence: LA MD04518R) |
| Enumeration Date | 2008-05-28 |
| Last Update Date | 2020-06-03 |