| NPI | 1083689053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME73700) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: AL 00026615) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: AL 00026615) | |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2007-12-19 |