| NPI | 1528021086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2005-00095) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: NC 200500095) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: NC 0200500095) | |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2019-12-03 |