| NPI | 1073014213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: FL OS17219) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: FL OS17219) |
| Enumeration Date | 2018-02-23 |
| Last Update Date | 2024-02-20 |