| NPI | 1114973021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: GA 014062) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: GA 014062) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2011-12-19 |