| NPI | 1255306965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: SC 16807) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: SC 16807) |
| 208VP0000X Pain Medicine Pain Medicine (Licence: SC 16807) | |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2007-08-01 |