| NPI | 1053793588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: SC 84138) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: SC 84138) |
| 207L00000X Anesthesiology (Licence: KY R3730) | |
| Enumeration Date | 2015-06-21 |
| Last Update Date | 2022-06-07 |