| NPI | 1730158627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: FL 74193) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: TN 37010) |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: TN 37010) | |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2024-04-13 |