| NPI | 1083600944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: FL ME126673) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: NE 22596) |
| 207LP2900X Anesthesiology Pain Medicine (Licence: WA MD00048913) | |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2024-07-18 |