| NPI | 1598781205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: TX D 5092) |
| Additional Taxonomies | 208800000X Urology (Licence: TX D5092) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2015-11-05 |