| NPI | 1407013691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: TX M9372) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: TX M9372) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: TX M9372) | |
| Enumeration Date | 2008-05-16 |
| Last Update Date | 2020-06-03 |