| NPI | 1679511786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: KY 41322) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: AL 00023531) |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: KY 41322) | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: KY 41322) | |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2021-09-27 |