| NPI | 1902802101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: OK 19721) |
| Additional Taxonomies | 174400000X Specialist (Licence: OK 19721) |
| 207Q00000X Family Medicine (Licence: OK 19721) | |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2018-04-10 |