| NPI | 1659377257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MS 15385) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TN 35059) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: CA G73878) | |
| Enumeration Date | 2005-06-28 |
| Last Update Date | 2016-10-20 |