| NPI | 1053360420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: KY 25415) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX H9449) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2013-06-24 |