| NPI | 1891055877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: KY KY49338) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: KY R2993) |
| Enumeration Date | 2012-05-23 |
| Last Update Date | 2017-04-27 |