| NPI | 1952561631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: TX S1757) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: PA MD436507) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: PA MD436507) | |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2022-11-12 |