| NPI | 1093776841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: KY 49262) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: KY 49262) |
| 2081P0004X Physical Medicine & Rehabilitation Spinal Cord Injury Medicine (Licence: TN 43140) | |
| 2081P0004X Physical Medicine & Rehabilitation Spinal Cord Injury Medicine (Licence: KY 49262) | |
| 208VP0000X Pain Medicine Pain Medicine (Licence: KY 49262) | |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2019-02-24 |