| NPI | 1346349453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: TX D-5354) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: TX D-5354) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2008-02-29 |