| NPI | 1174500821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101277437) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: SD 7446) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: SD 7446) | |
| Enumeration Date | 2005-12-23 |
| Last Update Date | 2023-07-11 |