| NPI | 1033471602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: UT 5169940-1204) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KS 9407846) |
| 207L00000X Anesthesiology (Licence: MT 49129) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: WY 11087a) | |
| Enumeration Date | 2012-06-11 |
| Last Update Date | 2021-09-22 |