| NPI | 1386662567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: TX L5788) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX L5788) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2021-01-27 |