| NPI | 1760040034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: MI 5101028077) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: MI 5151013516) |
| Enumeration Date | 2019-06-03 |
| Last Update Date | 2024-07-15 |