| NPI | 1699760769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: CA A90462) |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: NM 2000-07) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NM 2000-07) | |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2015-12-03 |