| NPI | 1013900976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: GA 49232) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: GA 49232) |
| 208VP0000X (Licence: GA 49232) | |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2015-02-09 |