| NPI | 1861590002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN DO1235) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: TN 00000260) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2015-06-19 |