| NPI | 1316400989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD70017317) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: WA MD70017317) |
| Enumeration Date | 2019-04-10 |
| Last Update Date | 2025-09-04 |