| NPI | 1073962296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MI 4301504323) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI B400115429237) |
| Enumeration Date | 2016-06-08 |
| Last Update Date | 2021-08-10 |