| NPI | 1861881542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD60962061) |
| Additional Taxonomies | 208VP0000X Pain Medicine Pain Medicine (Licence: WA MD60962061) |
| Enumeration Date | 2015-01-18 |
| Last Update Date | 2023-02-09 |