| NPI | 1104890011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OR MD12078) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: OR MD12078) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2013-09-09 |