| NPI | 1619001997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: PA MD431385) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: IA MD-45734) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2018-12-13 |