| NPI | 1891836656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: VA 0101253515) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0101253515) |
| 208600000X Surgery (Licence: MD d63269) | |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2020-10-27 |