| NPI | 1649268293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LA0401X Anesthesiology, Addiction Medicine (Licence: PA MD039680L) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA MD039680L) |
| Enumeration Date | 2005-10-07 |
| Last Update Date | 2025-03-31 |