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 |