| NPI | 1548555469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: TX S8810) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NJ 25MA10180200) |
| 207LP2900X Anesthesiology Pain Medicine (Licence: NY 279067) | |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2021-08-31 |