| NPI | 1740258805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AZ 11971) |
| Additional Taxonomies | 208VP0000X Pain Medicine Pain Medicine (Licence: AZ 11971) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2018-07-27 |