| NPI | 1679566145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: CO 29017) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CO 29017) |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2021-09-15 |