| NPI | 1255566642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX P6319) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: TX P6319) |
| Enumeration Date | 2009-05-28 |
| Last Update Date | 2018-04-04 |