| NPI | 1548235674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: KY 37636) |
| Additional Taxonomies | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: TN 45502) |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2013-09-24 |