| NPI | 1710114772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CA A116395) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: CA A116395) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: CA A116395) | |
| Enumeration Date | 2009-06-17 |
| Last Update Date | 2015-05-10 |