| NPI | 1063975068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX W0698) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: TX w0698) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CA A202546) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: CA A202546) | |
| Enumeration Date | 2019-04-08 |
| Last Update Date | 2025-11-24 |