| NPI | 1720063811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX V6111) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 313562-01) |
| 207L00000X Anesthesiology (Licence: MA 158846) | |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: TX V6111) | |
| Enumeration Date | 2005-12-12 |
| Last Update Date | 2025-02-12 |