| NPI | 1194163824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MD D0085432) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MD D0085432) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: MD D0085432) | |
| Enumeration Date | 2013-06-04 |
| Last Update Date | 2020-02-27 |