| NPI | 1134172745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: FL ME62441) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: GA 36001) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2011-08-17 |