| NPI | 1437361334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: SC MD35262) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: OH 57011532) |
| 208100000X Physical Medicine & Rehabilitation (Licence: TX N6674) | |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2016-07-12 |