| NPI | 1215918685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 200300512) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX M0851) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: MN 58992) | |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2025-11-13 |