NPI | 1316320864 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: CA A184155) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA A184155) |
2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NJ 25MA10871500) | |
208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: CA A184155) | |
Enumeration Date | 2015-07-01 |
Last Update Date | 2023-10-02 |