| NPI | 1588123657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MO 2023037897) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: IA DO-06342) |
| 207LP2900X Anesthesiology Pain Medicine (Licence: IA DO-06342) | |
| Enumeration Date | 2019-03-18 |
| Last Update Date | 2024-08-29 |