| NPI | 1871558536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MI 4301068183) |
| Additional Taxonomies | 204R00000X Electrodiagnostic Medicine (Licence: MI 4301068183) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: MI 4301068183) | |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2020-10-22 |