| NPI | 1134657943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: CA A166182) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX T8744) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: TX T8744) | |
| Enumeration Date | 2017-05-24 |
| Last Update Date | 2024-10-19 |