| NPI | 1215284062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: KY 49104) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: PA MD459374) |
| Enumeration Date | 2012-08-11 |
| Last Update Date | 2017-06-09 |