| NPI | 1013036359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: FL ME121742) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: FL ME121742) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2018-04-20 |