| NPI | 1861453193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN MD0000014656) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN MD14656) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: TN MD14656) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: TN MD0000014656) | |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2013-03-27 |