| NPI | 1609875624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 31740) |
| Additional Taxonomies | 174400000X Specialist (Licence: NC 31740) |
| 207LP2900X Anesthesiology Pain Medicine (Licence: NC 31740) | |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2019-08-23 |