| NPI | 1235226143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: WI 51406) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: WI 51406) |
| 208100000X Physical Medicine & Rehabilitation (Licence: WI 51406) | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2012-02-23 |