| NPI | 1710967237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD60833931) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VA 0101045085) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: VA 0101045085) | |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2020-12-01 |