| NPI | 1558324400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: WA MD 60266123) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VA 0101233157) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2013-10-30 |