| NPI | 1710167168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NC 2023-01908) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: NC 2023-01908) |
| 208100000X Physical Medicine & Rehabilitation (Licence: CA A94985) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: NC 2023-01908) | |
| Enumeration Date | 2007-11-13 |
| Last Update Date | 2024-01-08 |