| NPI | 1770711681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: FL OS12026) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL UO#: 2122) |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2022-09-14 |