| NPI | 1336375450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: VA 0101250991) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MO 2009001606) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MO 2009001606) | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: VA 0101250991) | |
| Enumeration Date | 2009-06-03 |
| Last Update Date | 2017-02-20 |