| NPI | 1609308469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: NC 2021-00267) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NC 2021-00267) |
| 208100000X Physical Medicine & Rehabilitation (Licence: NC 2021-00267) | |
| Enumeration Date | 2017-03-31 |
| Last Update Date | 2022-08-22 |