| NPI | 1467408682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: OR MD25340) |
| Additional Taxonomies | 174400000X Specialist (Licence: OR MD25340) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2022-05-18 |