| NPI | 1679610778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: WA MD00021183) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WA MD00021183) |
| 207LA0401X Anesthesiology, Addiction Medicine (Licence: WA MD00021183) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2023-10-11 |