| NPI | 1083740708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: WA MD 60057584) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA G77410) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2011-08-31 |