| NPI | 1871792135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL me98566) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME98566) |
| Enumeration Date | 2007-07-16 |
| Last Update Date | 2013-11-12 |