| NPI | 1558987024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD61541215) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: WA MD61541215) |
| Enumeration Date | 2020-06-22 |
| Last Update Date | 2024-08-08 |