| NPI | 1194827998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AK MEDS8005) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: SD 4424) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: WY 6326A) | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CA C51604) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: WY 6326A) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: SD 4424) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: CA C51604) | |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2022-11-16 |