| NPI | 1932753175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WI 83887) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 1014422) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: WI 83887) | |
| Enumeration Date | 2019-07-25 |
| Last Update Date | 2024-08-29 |