| NPI | 1063723518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MO 2010020465) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: MO 2014020135) |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2016-08-04 |