| NPI | 1578643383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: OK 27782) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 1852-850) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: OK 27782) | |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2021-01-14 |