| NPI | 1831185602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: FL ME58000) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL me58000) |
| Enumeration Date | 2005-09-27 |
| Last Update Date | 2024-06-21 |