| NPI | 1629051529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: CA 20A8068) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: AZ 4242) |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2020-12-18 |