| NPI | 1881891059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: SC 51991) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: VA 0102203023) |
| 207LP2900X Anesthesiology Pain Medicine (Licence: WV DO -2249) | |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2021-03-15 |