| NPI | 1376750612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: OH 35.096221) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: PA MD438381) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX N2502) | |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2022-11-29 |