| NPI | 1356637797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: WA OP60588011) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OR PG154727) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: FL OS13505) | |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2020-01-21 |