| NPI | 1952362634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: NC 2022-00092) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AL MD.41421) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2022-02-14 |