| NPI | 1407004880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine (Licence: KY 44283) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: FL ME102734) |
| 208100000X Physical Medicine & Rehabilitation (Licence: GA 64722) | |
| 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: KY 44283) | |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: KY 44283) | |
| Enumeration Date | 2008-08-28 |
| Last Update Date | 2014-04-23 |