| NPI | 1972509974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: MO 36747) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MO 36747) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: MO 36747) | |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2024-01-26 |