| NPI | 1497953749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MI 5315051155) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MT191166) |
| Enumeration Date | 2007-07-09 |
| Last Update Date | 2019-10-02 |