| NPI | 1144717026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: NC 2025-00795) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: NC 2025-00795) |
| 207L00000X Anesthesiology (Licence: TX BP10063865) | |
| Enumeration Date | 2018-04-17 |
| Last Update Date | 2025-04-28 |