| NPI | 1578635371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: AZ 56140) |
| Additional Taxonomies | 174400000X Specialist |
| 174400000X Specialist (Licence: CO 52254) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: CO 62254) | |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2023-11-27 |