| NPI | 1174819635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: CA A134257) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: CA A134257) |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2021-07-08 |