| NPI | 1376649541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: AZ 29183) |
| Additional Taxonomies | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: AZ 29183) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2010-09-13 |