| NPI | 1184159717 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: PA MD468155) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NJ 25MA11471300) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: PA MD468155) | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: DE C1-0025053) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NJ 25MA11471300) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: DE C1-0025053) | |
| Enumeration Date | 2017-04-20 |
| Last Update Date | 2025-02-18 |