NPI | 1073809224 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: WA 60621753) |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WI 6376820) |
208100000X Physical Medicine & Rehabilitation (Licence: WA 60621753) | |
Enumeration Date | 2011-06-27 |
Last Update Date | 2017-01-19 |