| NPI | 1497796916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: SC 33033) |
| Additional Taxonomies | 202K00000X (Licence: SC 33033) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NC 208100000X) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101240058) | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NC 2018-02730) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: SC 33033) | |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2024-02-26 |