| NPI | 1447299383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: CT 49724) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CT 049724) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2018-12-06 |