| NPI | 1447202205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 28914) |
| Additional Taxonomies | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: KY 28914) |
| 208VP0000X Pain Medicine Pain Medicine (Licence: KY 28914) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2013-01-09 |