| NPI | 1902874449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: VA 0101052685) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 010152685) |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2019-07-11 |