| NPI | 1184610990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: MO 2004006670) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: KS 04-22712) |
| Enumeration Date | 2005-09-27 |
| Last Update Date | 2020-12-09 |