| NPI | 1770519720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LA0401X Anesthesiology, Addiction Medicine (Licence: WA MD00031098) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WA MD00031098) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2019-07-30 |