| NPI | 1255590261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME111580) |
| Additional Taxonomies | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: FL ME111580) |
| Enumeration Date | 2008-06-04 |
| Last Update Date | 2021-09-21 |