| NPI | 1851734727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NE 32873) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: CA A162450) |
| 208100000X Physical Medicine & Rehabilitation (Licence: MO 2017014175) | |
| Enumeration Date | 2013-04-10 |
| Last Update Date | 2020-10-27 |