| NPI | 1104924109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: AK 210437) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: IN 01081532A) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: KY 37745) | |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2023-10-30 |