| NPI | 1063405306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: NC 9701215) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NC 9701215) |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2020-02-19 |