| NPI | 1992810790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA A106547) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CA A106547) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: CA A106547) | |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2019-10-14 |