| NPI | 1609862630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: MA 50393) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 50393) |
| 207L00000X Anesthesiology (Licence: NH 9652) | |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: NH 9652) | |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2015-10-23 |