| NPI | 1740608116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD61108449) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 68959-20) |
| 207LP2900X Anesthesiology Pain Medicine (Licence: WI 68959) | |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2022-06-02 |