| NPI | 1528276284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: MS 21401) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: MS 21401) |
| 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: AL DO1065) | |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: AL DO1065) | |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2018-10-04 |