| NPI | 1356801435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: NE 2922) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: UT 13268767-1204) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NE 2922) | |
| Enumeration Date | 2019-03-23 |
| Last Update Date | 2024-07-19 |