| NPI | 1700913456 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: PA MD047135L) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD047135L) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: WV 27284) | |
| Enumeration Date | 2007-02-28 |
| Last Update Date | 2022-08-24 |