| NPI | 1609850304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: TN MD0000016209) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TN MD00000162099) |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2011-11-11 |