| NPI | 1720616204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA OP61682891) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: WA OP61682891) |
| Enumeration Date | 2020-03-30 |
| Last Update Date | 2025-08-19 |