| NPI | 1760668164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P2900X Psychiatry & Neurology Pain Medicine (Licence: FL OS10281) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology Neurology (Licence: FL OS10281) |
| 208VP0000X Pain Medicine Pain Medicine (Licence: FL OS10281) | |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: FL OS10281) | |
| Enumeration Date | 2008-01-15 |
| Last Update Date | 2018-07-12 |