| NPI | 1639112055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CA A108113) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: PA MD425992) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NJ 25MA08008400) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2021-12-15 |