| NPI | 1568428589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: TX G1674) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX G1674) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2022-11-07 |