| NPI | 1629047766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: GA 48828) |
| Additional Taxonomies | 174400000X Specialist (Licence: GA 48228) |
| 208VP0000X Pain Medicine Pain Medicine (Licence: GA 48828) | |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2024-04-23 |