| NPI | 1639527443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: NE 30642) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 30642) |
| Enumeration Date | 2016-06-02 |
| Last Update Date | 2024-01-08 |