| NPI | 1669868220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: VA 0101266639) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: VA 0101266639) |
| Enumeration Date | 2015-04-10 |
| Last Update Date | 2023-08-10 |