| NPI | 1568606408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: WV 25084) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA MD-439805) |
| 207L00000X Anesthesiology (Licence: PA MT188551) | |
| 207LP2900X Anesthesiology Pain Medicine (Licence: LA MD 204524) | |
| Enumeration Date | 2009-04-22 |
| Last Update Date | 2019-04-22 |