| NPI | 1649463662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: FL ME113652) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4301090049) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: GA 68184) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: GA 68184) | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: GA 68184) | |
| Enumeration Date | 2007-08-22 |
| Last Update Date | 2015-11-04 |