| NPI | 1255569596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD446949) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NJ 25MA09494900) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: DE C1-0010450) | |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2022-02-18 |