| NPI | 1801883533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM 20020142) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: NM 20020142) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NM 20020142) | |
| Enumeration Date | 2005-09-27 |
| Last Update Date | 2013-01-10 |