| NPI | 1407824576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: GA 54547) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: GA 54547) |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: FL OS20454) | |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2023-12-26 |