| NPI | 1679765523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: GA 059870) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: GA 059870) |
| Enumeration Date | 2007-08-14 |
| Last Update Date | 2021-03-03 |