| NPI | 1104814797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PA 188099) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: PA OS-006810L) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: MS 18895) | |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: NY 188099) | |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: OH 6347) | |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: TN 1974) | |
| Enumeration Date | 2005-10-09 |
| Last Update Date | 2012-01-31 |