| NPI | 1205897956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NC 2008006962) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: TN MD0000021916) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: GA 047537) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: NC 2007-00624) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: MO 2008006962) | |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2014-01-14 |