| NPI | 1154946614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: MA 1019276) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT220347) |
| 207L00000X Anesthesiology (Licence: MA 288262) | |
| Enumeration Date | 2020-06-10 |
| Last Update Date | 2025-08-25 |