| NPI | 1295963155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine (Licence: PR 20619) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: PR 20619) |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2024-09-29 |