| NPI | 1376834838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: WA MD60632796) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA MD60632796) |
| Enumeration Date | 2011-05-02 |
| Last Update Date | 2016-11-28 |