| NPI | 1740210814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MD H53803) |
| Additional Taxonomies | 261QP3300X Clinic/Center, Pain (Licence: MD h00538003) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MD h53803) | |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2020-09-22 |