| NPI | 1386631869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MD D0060663) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: VA 0101237904) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CA A84906) | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MA 213-450) | |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2016-03-16 |