| NPI | 1205069275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: PR 18031) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PR 18031) |
| 207LP2900X Anesthesiology Pain Medicine (Licence: PR 18031) | |
| 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: PR 18031) | |
| Enumeration Date | 2009-08-25 |
| Last Update Date | 2015-09-06 |