| NPI | 1255327474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AZ 24192) |
| Additional Taxonomies | 174400000X Specialist (Licence: AZ 24192) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: AZ 24192) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: AZ 24192) | |
| Enumeration Date | 2005-09-22 |
| Last Update Date | 2019-12-04 |