| NPI | 1134682453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: GA 103684) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: FL 156201) |
| 207PS0010X Emergency Medicine, Sports Medicine (Licence: GA 103684) | |
| 207PS0010X Emergency Medicine, Sports Medicine (Licence: FL 156201) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL 156201) | |
| Enumeration Date | 2019-04-12 |
| Last Update Date | 2025-03-26 |