| NPI | 1154666139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL OS12339) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL UO 3325) |
| 208100000X Physical Medicine & Rehabilitation (Licence: FL OS12339) | |
| Enumeration Date | 2012-12-03 |
| Last Update Date | 2023-05-30 |