| NPI | 1538548300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NE 32558) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NE 32558) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: MN 61082) | |
| Enumeration Date | 2015-05-26 |
| Last Update Date | 2022-11-08 |