| NPI | 1477563369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: FL ME115817) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: CA A105673) |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: CA A105673) | |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: DE C1-0007425) | |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2017-10-18 |