| NPI | 1669662151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: AZ 36668) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 36668) |
| Enumeration Date | 2007-07-31 |
| Last Update Date | 2009-07-21 |