| NPI | 1750321568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: CA G81184) |
| Additional Taxonomies | 208VP0000X Pain Medicine Pain Medicine (Licence: CA G81184) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2025-07-14 |