| NPI | 1306006705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine (Licence: CA C160187) |
| Additional Taxonomies | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: NE 27244) |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2020-11-10 |