| NPI | 1831320035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX S4362) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: PA MD446378) |
| Enumeration Date | 2009-08-05 |
| Last Update Date | 2020-10-26 |