| NPI | 1053452979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: GA 61125) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: GA 061125) |
| 207LP3000X Anesthesiology Pediatric Anesthesiology (Licence: GA 061125) | |
| 208VP0000X Pain Medicine Pain Medicine (Licence: GA 061125) | |
| 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: GA 061125) | |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2019-08-29 |