| NPI | 1699766758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine (Licence: SC 19659) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: SC 19659) |
| 207L00000X Anesthesiology (Licence: GA 050251) | |
| 207LP2900X Anesthesiology Pain Medicine (Licence: SC 19659) | |
| Enumeration Date | 2005-10-28 |
| Last Update Date | 2020-09-04 |