| NPI | 1629286646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: LA 202018) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: KY TP-366) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2015-03-05 |