| NPI | 1124050265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CO DR0055201) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: GA 058074) |
| 207LP2900X Anesthesiology Pain Medicine (Licence: GA 058074) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2019-07-19 |