| NPI | 1083617963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101266664) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CT 042016) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: CT 042016) | |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2021-12-31 |