| NPI | 1386080638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: LA #390200000x) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: TN 57678) |
| Enumeration Date | 2013-05-14 |
| Last Update Date | 2021-08-05 |