| NPI | 1003132200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AL MD.31689) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX N5925) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: AL MD.31689) | |
| Enumeration Date | 2010-04-13 |
| Last Update Date | 2019-08-28 |