| NPI | 1669674206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: KY 48798) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 48798) |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2022-07-21 |