| NPI | 1346569704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: AZ 51508) |
| Additional Taxonomies | 174400000X Specialist (Licence: AZ 51508) |
| Enumeration Date | 2010-05-25 |
| Last Update Date | 2020-05-12 |