| NPI | 1073875969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: MA 269648) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 269648) |
| Enumeration Date | 2012-06-15 |
| Last Update Date | 2017-07-27 |