| NPI | 1508039496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2014-01468) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: KS T-01840) |
| 208100000X Physical Medicine & Rehabilitation (Licence: KY TP294) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: KY 46441) | |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: KY 46441) | |
| Enumeration Date | 2008-04-11 |
| Last Update Date | 2014-07-09 |