| NPI | 1386024222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: VA 0101261129) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116028053) |
| Enumeration Date | 2015-06-05 |
| Last Update Date | 2023-08-18 |