| NPI | 1275588501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NV 10382) |
| Additional Taxonomies | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: NV 10382) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2007-07-09 |