| NPI | 1376503250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MO R7F89) |
| Additional Taxonomies | 208600000X Surgery (Licence: MO R7F89) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MO R7F89) | |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2007-11-14 |