| NPI | 1003173543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WI 84159-20) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NH 18116) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: WI 84159-20) | |
| Enumeration Date | 2012-04-23 |
| Last Update Date | 2024-12-16 |