| NPI | 1356597330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: AR E9758) |
| Additional Taxonomies | 208D00000X General Practice (Licence: MI DO 5101018562) |
| 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: SC 1656) | |
| Enumeration Date | 2008-08-11 |
| Last Update Date | 2016-08-22 |