| NPI | 1356639140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: CO DR.0053629) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WY 12559A) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: WY 12559A) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: CO DR.0053629) | |
| Enumeration Date | 2011-07-14 |
| Last Update Date | 2020-06-30 |