| NPI | 1316025554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MO 2007011899) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2003023611) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2016-04-18 |