| NPI | 1124216387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RA0401X Internal Medicine Addiction Medicine (Licence: TN MD00018065) |
| Additional Taxonomies | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: TN MD00018065) |
| Enumeration Date | 2007-10-11 |
| Last Update Date | 2019-04-26 |