| NPI | 1225004963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: FL OS0007183) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: FL OS0007183) |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2021-10-12 |