| NPI | 1477636132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: LA MD.200294) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: LA MD.200294) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: LA MD.200294) | |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2007-07-08 |