| NPI | 1275572398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine (Licence: OK 24801) |
| Additional Taxonomies | 174400000X Specialist (Licence: OK 22294) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2010-03-01 |