| NPI | 1316926058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: GA 057737) |
| Additional Taxonomies | 174400000X Specialist (Licence: SC 23964) |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2012-10-24 |