| NPI | 1689688632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: VT 032-0000356) |
| Additional Taxonomies | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: VT 032-0000356) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: VT 032-0000356) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2015-08-18 |