| NPI | 1992794010 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: MT 10695)  | 
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MT 10695)  | 
| Enumeration Date | 2005-10-20 | 
| Last Update Date | 2012-09-28 |