| NPI | 1871571364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: MT 11677) |
| Additional Taxonomies | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: MT 11677) |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2021-05-03 |