| NPI | 1518054097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: OR 165737) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: OR 165737) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2020-09-01 |