| NPI | 1790752640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MS 09591) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OR MD13201) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: OR MD13201) | |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2018-01-18 |