| NPI | 1962602250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: LA 204474) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 231723) |
| Enumeration Date | 2007-07-24 |
| Last Update Date | 2025-08-27 |