| NPI | 1568435683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: MI 4301087096) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301087096) |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2009-02-23 |