| NPI | 1487631545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX M1288) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: TX M1288) |
| 208VP0000X Pain Medicine Pain Medicine (Licence: TX M1288) | |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2019-08-20 |