| NPI | 1043349244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PA MD030529E) |
| Additional Taxonomies | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: PA MD030529E) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2016-02-24 |