| NPI | 1205981867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MD H0069168) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MD H0069168) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MD H0069168) | |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2024-05-06 |