| NPI | 1063875250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: MD H00090961) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MD H00090961) |
| Enumeration Date | 2016-04-04 |
| Last Update Date | 2022-06-08 |