| NPI | 1700851466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X (Licence: SC 958) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: SC 958) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: SC 958) | |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2025-09-11 |