| NPI | 1073594693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: DE C1-0005467) |
| Additional Taxonomies | 204R00000X Electrodiagnostic Medicine (Licence: DE C1-0005467) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: DE C1-0005467) | |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2024-01-09 |