| NPI | 1124298344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: LA MD.201995) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: TX P2900) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: LA MD.201995) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX P2900) | |
| Enumeration Date | 2008-03-04 |
| Last Update Date | 2019-05-28 |