| NPI | 1609833516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: SC 22912) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: GA 78001) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: GA 78001) | |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2025-03-10 |