| NPI | 1104858521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WV 15563) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: SC 22635) |
| 207L00000X Anesthesiology (Licence: PA MD465074) | |
| 207L00000X Anesthesiology (Licence: OH 35.079981) | |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: WV 15563) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2024-05-23 |