| NPI | 1013108232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: WA 60811752) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: MD D0087563) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2025-01-02 |