| NPI | 1568459667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: ME MD22859) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KY 34465) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: KY 34465) | |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2022-02-03 |