| NPI | 1790883627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: SC MMD.39240) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WV 21895) |
| 207L00000X Anesthesiology (Licence: VA 0101242390) | |
| 207L00000X Anesthesiology (Licence: NC 2016-02291) | |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2022-08-04 |