| NPI | 1376755538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: GA 54617) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: GA 054617) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2025-06-04 |