| NPI | 1104993773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TN MD0000008283) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TN MD0000008283) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: TN MD0000008283) | |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2007-07-16 |