| NPI | 1811254105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: KY 04206) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: KY TP992) |
| Enumeration Date | 2012-04-12 |
| Last Update Date | 2022-09-19 |