| NPI | 1700222809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL OS14592) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MD H0080883) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: FL OS14592) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MD H0080883) | |
| Enumeration Date | 2013-05-15 |
| Last Update Date | 2018-03-17 |