| NPI | 1194754622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: KY 49097) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OH 35-084075) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: IN 01065012A) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: OH 35084075) | |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2021-08-10 |