| NPI | 1720499759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: WI 67188) |
| Additional Taxonomies | 208VP0000X (Licence: WI 67188) |
| 208100000X Physical Medicine & Rehabilitation (Licence: WI 67188) | |
| Enumeration Date | 2014-05-13 |
| Last Update Date | 2026-04-21 |