| 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 |