| NPI | 1700061918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OK 28562) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX M8853) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: OK 28562) | |
| Enumeration Date | 2008-01-07 |
| Last Update Date | 2020-09-04 |