| NPI | 1942405238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AK MEDS7779) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VA 0101245113) |
| 207LP2900X Anesthesiology Pain Medicine (Licence: VA 0101245113) | |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2025-02-25 |