| NPI | 1235342775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: AZ 42990) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 42990) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: AZ 42990) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: AZ 42990) | |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2022-01-10 |