| NPI | 1285781872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: TX E5827) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX E5827) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2021-09-01 |