| NPI | 1710305768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: ID O-1201) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX Q8621) |
| Enumeration Date | 2014-04-06 |
| Last Update Date | 2022-04-13 |