| NPI | 1003107285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: MO 2024031248) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX P5248) |
| 207L00000X Anesthesiology (Licence: NY 260092-1) | |
| 207L00000X Anesthesiology (Licence: MO 2024031248) | |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: TX P5248) | |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: NY 260092) | |
| Enumeration Date | 2011-04-22 |
| Last Update Date | 2024-10-03 |