| NPI | 1124123310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 2016-01371) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CA A40711) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: CA A40711) | |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2016-09-15 |