| NPI | 1750887089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: MO 2023027409) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: IA R-12350) |
| Enumeration Date | 2018-04-04 |
| Last Update Date | 2023-07-26 |