| NPI | 1487640090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WI 102354) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VA 0101053809) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: VA 0101053809) | |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2025-01-08 |