| NPI | 1053431635 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: GA 058811) | 
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: GA 058811) | 
| Enumeration Date | 2007-03-29 | 
| Last Update Date | 2008-06-16 |