| NPI | 1972921617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL OS13955) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL OS13955) |
| Enumeration Date | 2014-03-31 |
| Last Update Date | 2023-08-24 |