| NPI | 1225371818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: LA 304483) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AL DO1858) |
| 208100000X Physical Medicine & Rehabilitation (Licence: CA 20A15518) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: MS 25859) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MS 25859) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: AL DO1858) | |
| Enumeration Date | 2013-04-02 |
| Last Update Date | 2019-08-26 |