| NPI | 1124016464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: ID M8818) |
| Additional Taxonomies | 208VP0000X Pain Medicine Pain Medicine (Licence: ID M8818) |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2018-01-10 |