| NPI | 1124232855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301086579) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MI 4301086579) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: MI 4301086579) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: MI 4301086579) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MI 4301086579) | |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2024-03-26 |