| NPI | 1710220413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: CO DR0060890) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: SC 84899) |
| 208VP0000X (Licence: CO DR0060890) | |
| Enumeration Date | 2013-04-01 |
| Last Update Date | 2026-04-23 |