| NPI | 1982803284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL OS11178) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0102202622) |
| 208100000X Physical Medicine & Rehabilitation (Licence: PA OS014626) | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: FL OS11178) | |
| Enumeration Date | 2007-07-16 |
| Last Update Date | 2019-08-20 |