| NPI | 1942394127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: VA 0101050257) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MD D0050548) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2021-02-03 |