| NPI | 1114094935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TN 44373) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: TN 44373) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: GA 069072) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: GA 069072) | |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2015-07-13 |