| NPI | 1881013647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine (Licence: KY 04506) |
| Additional Taxonomies | 208VP0000X Pain Medicine Pain Medicine (Licence: IN 02005642A) |
| 208VP0000X Pain Medicine Pain Medicine (Licence: IL 036149269) | |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2022-06-14 |