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 |