| NPI | 1538180765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: ND 9573) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: ND 9573) |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2012-01-19 |