| NPI | 1922549211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: LA 310878) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: LA 310787) |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2023-12-28 |