| 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 |