| NPI | 1982603106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: OR 10955) |
| Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: OR 10955) |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2008-06-05 |