| NPI | 1114952991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: VA 0101058044) |
| Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: ME MD16785) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2024-09-03 |