| NPI | 1053416313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: KY 26259) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: KY 26259) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2020-06-09 |