| NPI | 1497792097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: AZ 31052) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 31052) |
| 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: AZ 31052) | |
| 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: AZ 31052) | |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2019-11-07 |