| NPI | 1861720286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL OS11419) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MI 5101017027) |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: MI 5101017027) | |
| Enumeration Date | 2009-11-23 |
| Last Update Date | 2018-12-10 |