| NPI | 1255338042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL ME79194) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME79194) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2017-10-12 |