| NPI | 1205807971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: AZ 26875) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: AZ 29875) |
| 208VP0000X Pain Medicine Pain Medicine (Licence: AZ 29875) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: AZ 26875) | |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2024-04-23 |