| NPI | 1992936710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WY 8981a) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: WY 8981A) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: WY 8981A) | |
| Enumeration Date | 2009-07-28 |
| Last Update Date | 2021-07-26 |