| NPI | 1831177807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: NV 11341) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NV 11341) |
| 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: NV 111341) | |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: CA A54756) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: CA A54756) | |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2023-07-16 |