| NPI | 1417042805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: NH 14887) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MN 102519) |
| 171100000X Acupuncturist | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2022-05-05 |