| NPI | 1609926146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME107132) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL TRN10170) |
| 207LP2900X Anesthesiology Pain Medicine (Licence: GA 065822) | |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2011-05-18 |