| NPI | 1730113770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME132102) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX L5166) |
| 207L00000X Anesthesiology (Licence: PA MD429943) | |
| 207LP2900X Anesthesiology Pain Medicine (Licence: PA MD429943) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2023-03-07 |