| NPI | 1912965013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NH 19566) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NC 2008-01153) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: NC 2008-01153) | |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2019-04-23 |