| NPI | 1588787162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: GA 027027) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: GA 027027) |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2010-03-25 |