| NPI | 1467619254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: LA MD.200721) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: LA 200721) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: LA 200721) | |
| Enumeration Date | 2008-05-20 |
| Last Update Date | 2021-04-12 |