| NPI | 1972718658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: WY 8973A) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: IA R-9048) |
| 207R00000X Internal Medicine (Licence: PA MT187835) | |
| 207LP2900X Anesthesiology Pain Medicine (Licence: ID M-12141) | |
| 207L00000X Anesthesiology (Licence: SD 9063) | |
| 207LP2900X Anesthesiology Pain Medicine (Licence: UT 8622635-1205) | |
| 207L00000X Anesthesiology (Licence: MI 4301091543) | |
| 207LP2900X Anesthesiology Pain Medicine (Licence: MT MED-PHYS-LIC-29693) | |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2014-03-05 |