| NPI | 1922205079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: NC 2016-00023) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: VA 0101252883) |
| 207R00000X Internal Medicine (Licence: MA 232877) | |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2016-07-06 |