| NPI | 1104860394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX M2713) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MO 2010014118) |
| 207L00000X Anesthesiology (Licence: AR E6366) | |
| 207L00000X Anesthesiology (Licence: NY 232160) | |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: NY 232160) | |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: TX M2713) | |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2022-10-11 |