| NPI | 1982679932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: TX L6764) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX L6764) |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2019-10-30 |