| NPI | 1902861495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI HR077496) |
| Additional Taxonomies | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: MI 4301077496) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2024-01-04 |