| NPI | 1720278500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2018-01336) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: VA 0102202405) |
| 208100000X Physical Medicine & Rehabilitation (Licence: VA 0102202405) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NC 2018-01336) | |
| Enumeration Date | 2007-07-27 |
| Last Update Date | 2019-06-11 |