| NPI | 1154472017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: TX M2686) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: TX M2686) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX M2686) | |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2022-08-03 |