| NPI | 1811965924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX E8631) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: NE 15117) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2023-11-01 |