| NPI | 1750842464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: WI 82914) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MN 67859) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: FL ME160640) | |
| Enumeration Date | 2019-03-26 |
| Last Update Date | 2024-08-19 |