| NPI | 1841516937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: WI 73388) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: MN 67512) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TN MD0000052702) | |
| Enumeration Date | 2010-04-14 |
| Last Update Date | 2020-12-17 |