| NPI | 1487641130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WY 8168A) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: CO 33815) |
| Enumeration Date | 2005-09-27 |
| Last Update Date | 2026-01-22 |