| NPI | 1952656399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: GA 069698) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NY 265837-1) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: GA 069698) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: GA 069698) | |
| Enumeration Date | 2012-07-23 |
| Last Update Date | 2018-09-20 |