| NPI | 1720109176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CA A104338) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA L-226376) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: CA A104338) | |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2019-01-17 |