| NPI | 1013980119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MN 45952) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: UT 6414842-1204) |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2022-07-21 |