| NPI | 1417940990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: NC 2014-01917) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA MD420312L) |
| 207L00000X Anesthesiology (Licence: NC 2014-01917) | |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2021-04-01 |