| NPI | 1679856710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL OS11794) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: FL OS11794) |
| 208D00000X General Practice (Licence: FL UO2718) | |
| Enumeration Date | 2011-09-26 |
| Last Update Date | 2018-05-14 |