| NPI | 1104005941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: SC 18323) |
| Additional Taxonomies | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: SC 18323) |
| Enumeration Date | 2007-10-29 |
| Last Update Date | 2014-09-25 |