| NPI | 1154332138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX M1970) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX M1970) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2019-12-16 |