| NPI | 1376723981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: CT 66872) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA MT195756) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: WA MD60272371) | |
| Enumeration Date | 2007-11-12 |
| Last Update Date | 2021-10-19 |