| NPI | 1043223597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: CT 66608) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: NY 1678921) |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2020-10-20 |