| NPI | 1053572800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: GA 81392) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: NC 2012-00569) |
| Enumeration Date | 2008-06-24 |
| Last Update Date | 2020-09-17 |