| NPI | 1770710840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: FL ME119606) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA MD437104) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NY 263028-1) | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NC 2013-01080) | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: FL ME119606) | |
| Enumeration Date | 2009-06-16 |
| Last Update Date | 2021-04-26 |