| NPI | 1700919024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MI 4301091372) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: IA 34832) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2014-07-03 |