| NPI | 1154311736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: KY 21261) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: KY 21261) |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2010-09-13 |