| NPI | 1659351211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 9754) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MT 9754) |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2007-07-08 |