| NPI | 1063078921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101279255) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: VA 0101279255) |
| Enumeration Date | 2019-05-16 |
| Last Update Date | 2023-07-27 |