| NPI | 1477734721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: TX N6287) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX N6287) |
| 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: TX N6287) | |
| Enumeration Date | 2007-11-15 |
| Last Update Date | 2020-02-17 |