| NPI | 1164710430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MT MED-PHYS-LIC-43241) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 60323-20) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: WI 60323-20) | |
| Enumeration Date | 2011-07-20 |
| Last Update Date | 2015-11-03 |