| NPI | 1124033097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX M2546) |
| Additional Taxonomies | 208VP0000X Pain Medicine Pain Medicine (Licence: TX M2546) |
| Enumeration Date | 2006-07-29 |
| Last Update Date | 2021-08-20 |