| NPI | 1629410519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA A131189) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 65678) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: WI 65678) | |
| Enumeration Date | 2013-07-22 |
| Last Update Date | 2023-03-07 |