| NPI | 1700025400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PA LT000669) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: PA LT000669) |
| Enumeration Date | 2009-02-19 |
| Last Update Date | 2009-02-19 |