| NPI | 1679541122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: VA 0102201571) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: MD H0060855) |
| 208100000X Physical Medicine & Rehabilitation (Licence: VA 0102201571) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: MD H60855) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: VA 0102201571) | |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2022-11-08 |