| NPI | 1548203961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA 00A63460) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: CA A63460) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: CA A63460) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2019-06-11 |