| NPI | 1114964251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: RI MD08249) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MA 257798) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: RI MD08249) | |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2021-03-30 |