| NPI | 1659384014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: PA OS013632) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: PA OS013632) |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2021-09-15 |