| NPI | 1992728141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: SC 184375) |
| Additional Taxonomies | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: NC 200200419) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2021-01-29 |