| NPI | 1790766319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TN 26759) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TN 26759) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: TN MD26759) | |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2018-10-03 |