| NPI | 1841483542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MO 2011008750) |
| Additional Taxonomies | 208VP0000X (Licence: KS 04-36720) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: KS 04-36720) | |
| Enumeration Date | 2007-08-26 |
| Last Update Date | 2016-10-25 |