| NPI | 1942294004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: SC 81664) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MA 78809) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NH 11526) | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MA 78809) | |
| Enumeration Date | 2005-09-06 |
| Last Update Date | 2020-10-27 |