| NPI | 1679674014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 200301289) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME79191) |
| 207LP2900X Anesthesiology Pain Medicine (Licence: NC 200301289) | |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2025-04-17 |