| NPI | 1851650709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NE 29991) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 61615) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: WI 61615) | |
| Enumeration Date | 2012-05-14 |
| Last Update Date | 2018-07-03 |