| NPI | 1972094647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: MO 2023029524) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KS 94-09558) |
| Enumeration Date | 2018-05-29 |
| Last Update Date | 2025-05-08 |