| NPI | 1568458636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME89281) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: GA 054570) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: GA 054570) | |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2019-12-13 |