| NPI | 1104386853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: FL ME166357) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC H0071) |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2024-03-27 |