| NPI | 1952366775 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: OR MD18705) | 
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: OR MD18705) | 
| Enumeration Date | 2006-04-18 | 
| Last Update Date | 2018-10-15 |