| NPI | 1962963223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X (Licence: NV DO3631) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: NV DO3631) |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2026-04-22 |