| NPI | 1417240961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA OP60640664) |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: WA OP60640664) |
| 207L00000X Anesthesiology (Licence: WI 103131-875) | |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: WA OP60640664) | |
| 207L00000X Anesthesiology (Licence: TX P9464) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: ID O-1293) | |
| Enumeration Date | 2011-05-17 |
| Last Update Date | 2026-01-27 |