| NPI | 1366406167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: LA 10231R) |
| Additional Taxonomies | 174400000X Specialist (Licence: MS 14529) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: LA MD.10231R) | |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2020-11-06 |