| NPI | 1588227946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: WA 61430849) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: WA MD61430849) |
| Enumeration Date | 2019-04-20 |
| Last Update Date | 2024-03-12 |