| NPI | 1104818095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: TX N9382) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: AR e3708) |
| Enumeration Date | 2005-08-17 |
| Last Update Date | 2014-06-03 |