| NPI | 1154445203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: WA OP60077457) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA OP60077457) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2013-04-17 |