| NPI | 1518287291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: NC 2016-01678) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: NC 201601678) |
| Enumeration Date | 2010-06-04 |
| Last Update Date | 2023-02-09 |