| NPI | 1083975916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: WI 77772-20) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WI 77772-20) |
| Enumeration Date | 2012-06-07 |
| Last Update Date | 2024-04-16 |