| NPI | 1275821738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: RI MD16583) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: KS 9407405) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MO 2010022104) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: WI 60586-20) | |
| Enumeration Date | 2011-07-19 |
| Last Update Date | 2019-11-13 |