| NPI | 1295222420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NV 28320) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NV 28320) |
| 208100000X Physical Medicine & Rehabilitation (Licence: FL ME161689) | |
| Enumeration Date | 2018-04-13 |
| Last Update Date | 2026-07-31 |