| NPI | 1487723003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: VA 0102201689) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: VA 0102201689) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2012-03-14 |