| NPI | 1790110112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 007600) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OH 58.004993) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: AZ 007600) | |
| Enumeration Date | 2013-09-04 |
| Last Update Date | 2023-07-28 |