| NPI | 1770966707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: PA OS020483) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA OT016796) |
| Enumeration Date | 2015-07-08 |
| Last Update Date | 2020-07-10 |