| NPI | 1063648541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PA MD451410) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: PA ND451410) |
| Enumeration Date | 2009-06-10 |
| Last Update Date | 2021-03-02 |