| NPI | 1487621462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: VA 0101035326) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101035326) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2021-07-26 |