| NPI | 1720074800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: AZ 50242) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 50242) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: AZ 50242) | |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2023-09-06 |