| NPI | 1154375319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD00041887) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: GA 035678) |
| 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: GA 035678) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: GA 035678) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: GA 035678) | |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2019-08-27 |