| NPI | 1912401761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: WA MD61436438) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME155190) |
| Enumeration Date | 2018-03-19 |
| Last Update Date | 2025-11-06 |