| NPI | 1063944080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: AZ 008994) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MN 64383) |
| Enumeration Date | 2017-03-29 |
| Last Update Date | 2021-08-26 |