| NPI | 1740556653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MN 57098) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: IN 390200000X) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MN 107043) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: MN 57098) | |
| Enumeration Date | 2012-03-25 |
| Last Update Date | 2016-06-28 |