| NPI | 1508216680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: MS 27726) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: UT 11550462-1205) |
| 208600000X Surgery (Licence: PA MT211207) | |
| Enumeration Date | 2016-06-20 |
| Last Update Date | 2021-08-30 |