| NPI | 1306051834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: HI 13507) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: HI 13507) |
| 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: HI 13507) | |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2022-09-06 |