| NPI | 1649238734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: LA MD.12613R) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: LA MD.12613R) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2017-05-08 |