| NPI | 1578098026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4351036615) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MI 4301506287) |
| Enumeration Date | 2017-04-21 |
| Last Update Date | 2025-10-21 |