| NPI | 1467553966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: FL ME121364) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: OH 35084603) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2019-09-05 |