| NPI | 1497073530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: KY 47256) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: KY R2316) |
| 208VP0000X Pain Medicine Pain Medicine (Licence: KY 47256) | |
| Enumeration Date | 2010-05-13 |
| Last Update Date | 2023-11-27 |