| NPI | 1952659773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine (Licence: ND 11490) |
| Additional Taxonomies | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: ND 11490) |
| Enumeration Date | 2012-08-28 |
| Last Update Date | 2021-07-15 |