| NPI | 1699703066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: TX M4663) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: PA MT179497) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2020-06-03 |