| NPI | 1639169758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MA 77175) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: MA 77175) |
| Enumeration Date | 2005-10-28 |
| Last Update Date | 2008-06-03 |