| NPI | 1629060405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX H6111) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: TX H6111) |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2021-01-27 |