| NPI | 1710240791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: OR DO18466) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: OR DO.18466) |
| Enumeration Date | 2012-06-24 |
| Last Update Date | 2024-03-28 |