| NPI | 1255960225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL OS21131) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL OS21131) |
| Enumeration Date | 2020-04-02 |
| Last Update Date | 2025-11-05 |