| NPI | 1740328053 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: GA 044142)  | 
| Additional Taxonomies | 207LP3000X Anesthesiology, Pediatric Anesthesiology (Licence: GA 044142)  | 
| 208VP0000X  (Licence: GA 044142)  | |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: GA 044142)  | |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: GA 044142)  | |
| Enumeration Date | 2007-02-01 | 
| Last Update Date | 2019-08-27 |