| NPI | 1255516183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NM MD2024-0544) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: GA 61825) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: GA 61825) | |
| Enumeration Date | 2008-01-09 |
| Last Update Date | 2024-07-05 |