| NPI | 1447308689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: VA 0101252651) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: SC 19477) |
| 208100000X Physical Medicine & Rehabilitation (Licence: SC 19477) | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: SC 19477) | |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: SC 19477) | |
| Enumeration Date | 2007-01-06 |
| Last Update Date | 2018-07-23 |