| NPI | 1245611755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: SD 13187) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: NE 32608) |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2022-03-01 |