| NPI | 1689060055 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WI 66352 - 20) | 
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: WI 66352) | 
| Enumeration Date | 2015-04-12 | 
| Last Update Date | 2019-07-23 |