| NPI | 1508258559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: CA A163057) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CA A163057) |
| 208VP0000X (Licence: CA A163057) | |
| Enumeration Date | 2015-02-28 |
| Last Update Date | 2026-06-15 |