| NPI | 1083034557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: LA 308434) |
| Additional Taxonomies | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: LA 308434) |
| Enumeration Date | 2014-04-23 |
| Last Update Date | 2019-08-05 |