NPI | 1417934290 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: AZ 29900) |
Additional Taxonomies | 174400000X Specialist (Licence: AZ 29900) |
Enumeration Date | 2005-12-22 |
Last Update Date | 2019-04-03 |