| NPI | 1891907325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: OK 24801) |
| Additional Taxonomies | 174400000X Specialist (Licence: OK 22294) |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2022-08-15 |