| NPI | 1760673206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: FL ME147230) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MI 4301089505) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: IL 036.115520) | |
| Enumeration Date | 2007-08-08 |
| Last Update Date | 2021-04-20 |