| NPI | 1285629667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: TN MD-56883) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: IA MD-28604) |
| Enumeration Date | 2005-09-13 |
| Last Update Date | 2023-03-07 |