| NPI | 1740500958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AL DO1456) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: AL DO.1456) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MS 23604) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: MS 23604) | |
| Enumeration Date | 2010-06-10 |
| Last Update Date | 2019-01-24 |