| NPI | 1932379872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: LA 205239) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: LA MD.205239) |
| 208100000X Physical Medicine & Rehabilitation (Licence: LA ac3351020751) | |
| Enumeration Date | 2008-03-06 |
| Last Update Date | 2025-01-07 |