| NPI | 1841276714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: FL meoo42339) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: AL 00019674) |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2007-07-24 |