| NPI | 1508129826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: WI 65124) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 65124) |
| 208100000X Physical Medicine & Rehabilitation (Licence: WI 65124) | |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2024-04-10 |