NPI | 1972914869 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine (Licence: FL ME135621) |
Additional Taxonomies | 2084P2900X Psychiatry & Neurology Pain Medicine (Licence: IL 036148150) |
Enumeration Date | 2014-05-13 |
Last Update Date | 2022-05-31 |