| NPI | 1740377787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: GA 57620) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: GA 57620) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2022-10-26 |