| NPI | 1083078752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: MO 2023025583) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: KY 56670) |
| Enumeration Date | 2016-04-08 |
| Last Update Date | 2023-10-09 |