| NPI | 1679884894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: WA MD61137848) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: NV 15749) |
| Enumeration Date | 2010-06-23 |
| Last Update Date | 2021-11-24 |