| NPI | 1689170532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: CO DR.0063079) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CO DR.0063079) |
| Enumeration Date | 2018-03-31 |
| Last Update Date | 2024-07-09 |