| NPI | 1972560944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: GA 41180) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: TN 27354) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2010-08-05 |