| NPI | 1902292519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: NY 304661) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: TX S0488) |
| Enumeration Date | 2015-04-09 |
| Last Update Date | 2021-09-07 |