| NPI | 1205078987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine (Licence: KY 03360) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: KY 03360) |
| Enumeration Date | 2009-03-27 |
| Last Update Date | 2025-07-24 |