| NPI | 1447209895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: CT 040627) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CT 040627) |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: CT 040627) | |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2013-05-20 |