| NPI | 1811104664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: TX N2402) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: IA R7380) |
| 207L00000X Anesthesiology (Licence: IA 37699) | |
| 207L00000X Anesthesiology (Licence: NC 2008-00257) | |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2022-03-03 |