| NPI | 1700867587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: MO MD109218) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: KS 04-27858) |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2008-11-07 |