| NPI | 1033420211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: CA 125881) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NC 5021602) |
| 282N00000X General Acute Care Hospital (Licence: PA MT198014) | |
| Enumeration Date | 2010-06-23 |
| Last Update Date | 2025-10-01 |