| NPI | 1053502716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: GA 070224) |
| Additional Taxonomies | 2081S0010X Physical Medicine & Rehabilitation Sports Medicine (Licence: GA 070224) |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: GA 070224) | |
| Enumeration Date | 2007-08-07 |
| Last Update Date | 2013-07-31 |