| NPI | 1821104795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: WI 17363020) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WI 17363020) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2023-03-07 |