| NPI | 1912136110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WI 69958) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: VA 0101247917) |
| Enumeration Date | 2009-07-08 |
| Last Update Date | 2020-08-04 |