| NPI | 1992147029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2019-01947) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL UO3440) |
| 208100000X Physical Medicine & Rehabilitation (Licence: FL OS13352) | |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: SC 82190) | |
| Enumeration Date | 2013-07-17 |
| Last Update Date | 2024-02-22 |