| NPI | 1477509693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: AZ 34177) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 34177) |
| 225400000X Rehabilitation Practitioner (Licence: AZ 34177) | |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2024-03-01 |