| NPI | 1235104431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 36200) |
| Additional Taxonomies | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: AZ 36200) |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2022-09-14 |