| NPI | 1053399113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: WV 23967) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA MD424234) |
| Enumeration Date | 2006-01-08 |
| Last Update Date | 2011-09-22 |