| NPI | 1821167412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MN 49963) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL OS 11219) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: UT 8066451-1204) | |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2023-10-24 |