| NPI | 1750426987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: VA 0102201888) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: VA 0102201888) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: VA 0102201888) | |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2023-08-15 |