| NPI | 1063883585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: FL OS18809) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL OS18809) |
| 208D00000X General Practice (Licence: NC 2016-02336) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL OS18809) | |
| Enumeration Date | 2015-10-09 |
| Last Update Date | 2024-12-22 |