| NPI | 1053349985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WV 23896) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MD D0063836) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: WV 23896) | |
| 207L00000X Anesthesiology (Licence: WI 3169) | |
| 207LA0401X Anesthesiology, Addiction Medicine (Licence: WV 23896) | |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2023-09-22 |