| NPI | 1609832229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: TN 000026097) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: GA 046733) |
| Enumeration Date | 2006-04-22 |
| Last Update Date | 2016-12-28 |