| NPI | 1972706448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: MD H0076404) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: VA 0102202963) |
| 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MD H0076404) | |
| Enumeration Date | 2007-06-11 |
| Last Update Date | 2021-06-18 |