| NPI | 1649565425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PA OS016220) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: PA OS016220) |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: PA OS016220) | |
| Enumeration Date | 2011-06-09 |
| Last Update Date | 2022-04-18 |