| NPI | 1396290946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AL 38439) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: AL 38439) |
| Enumeration Date | 2016-08-23 |
| Last Update Date | 2023-07-06 |