| NPI | 1003178146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: TX R1450) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: GA 072668) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: GA 072668) | |
| Enumeration Date | 2012-06-14 |
| Last Update Date | 2020-10-15 |