| NPI | 1134186752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: RI MD10503) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: RI 10503) |
| 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: RI 10503) | |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2013-10-04 |