| NPI | 1417999632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL ME5179) |
| Additional Taxonomies | 174400000X Specialist (Licence: LA 015182) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2020-02-26 |