| NPI | 1790348480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: WI 83065-20) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 1014761) |
| 207L00000X Anesthesiology (Licence: WI 83065-20) | |
| 207LP2900X Anesthesiology Pain Medicine (Licence: MA 1014761) | |
| Enumeration Date | 2019-04-17 |
| Last Update Date | 2025-06-24 |