| NPI | 1396950051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: TX M9482) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX M9482) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2022-09-29 |