| NPI | 1760778906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: AZ 52281) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AZ R72526) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: AZ 52281) | |
| Enumeration Date | 2011-06-27 |
| Last Update Date | 2020-06-02 |