| NPI | 1811989577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: TX F9183) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX f9183) |
| 2085R0204X Radiology, Vascular & Interventional Radiology (Licence: TX F9183) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX F9183) | |
| 208VP0000X (Licence: TX F9183) | |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2014-12-01 |