| NPI | 1306817481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: WA MD00040561) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: WA MD00040561) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2012-06-28 |