| NPI | 1760598619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX S3688) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: TX S3688) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: FL ME105992) | |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2022-10-31 |