| NPI | 1972844561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: CA 16433) |
| Additional Taxonomies | 207LA0401X Anesthesiology, Addiction Medicine (Licence: CA 16433) |
| 208VP0000X (Licence: CA 16433) | |
| Enumeration Date | 2013-03-07 |
| Last Update Date | 2024-02-22 |