| NPI | 1457640708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: MI 4301098087) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4301098087) |
| 207LA0401X Anesthesiology, Addiction Medicine (Licence: MI 4301098087) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301098087) | |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MI 4301098087) | |
| Enumeration Date | 2011-04-06 |
| Last Update Date | 2025-04-18 |