| NPI | 1790129435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NH 17536) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 271554) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: MA 271554) | |
| Enumeration Date | 2013-04-24 |
| Last Update Date | 2018-06-28 |