| NPI | 1972625853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: KS 534506) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: GA 062351) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: OK 5654) | |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2015-04-07 |