| NPI | 1376552919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: GA 025314) |
| Additional Taxonomies | 174400000X Specialist (Licence: GA 025314) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2010-09-10 |