| NPI | 1952393688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TN MD30702) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: TN Md30702) |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2013-07-17 |