| NPI | 1851350292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WY 7591A) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: SC 24055) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: WY 7591A) | |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2021-02-19 |