NPI | 1306036942 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: LA 201144) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: LA 201144) |
Enumeration Date | 2007-07-30 |
Last Update Date | 2021-05-20 |