| NPI | 1083804579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: FL ME105392) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: PA MD432710) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: OH 35.092901) | |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: NE 25732) | |
| Enumeration Date | 2007-07-31 |
| Last Update Date | 2019-05-29 |