| NPI | 1760463939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: MO MDR6E36) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: KS 04-23571) |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2008-11-07 |