| NPI | 1124075056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: ID M6844) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: ID M6844) |
| 208D00000X General Practice (Licence: ID M6844) | |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2017-12-14 |