| NPI | 1619003746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: GA 060517) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: GA 060517) |
| 208100000X Physical Medicine & Rehabilitation (Licence: FL OS10135) | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: FL OS10135) | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: GA 60517) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL OS10135) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: GA 060517) | |
| Enumeration Date | 2007-02-25 |
| Last Update Date | 2022-10-23 |