| NPI | 1164632311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: NC 2014-00019) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2014-00019) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NC 2104-00019) | |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2018-04-03 |