| NPI | 1730371501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MD D0070457) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101241796) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: VA 0101241796) | |
| Enumeration Date | 2007-08-15 |
| Last Update Date | 2023-12-14 |