| NPI | 1811035371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: GA 90878) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KY R1017) |
| 207LP2900X Anesthesiology Pain Medicine (Licence: AL MD.29480) | |
| Enumeration Date | 2007-02-04 |
| Last Update Date | 2022-01-04 |