| NPI | 1639285182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: WA MD00046493) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2007-01763) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2021-05-10 |