| NPI | 1467415976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine (Licence: NV 3895) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NV 3895) |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2022-08-12 |