| NPI | 1932153236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: AZ 37166) |
| Additional Taxonomies | 174400000X Specialist (Licence: LA L15479R) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2020-02-19 |