| NPI | 1679679153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: MA 210723) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 210723) |
| 207LA0401X Anesthesiology, Addiction Medicine (Licence: MA 210723) | |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2016-08-03 |