| NPI | 1164427001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA A69385) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: CA A69385) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2019-07-23 |