| NPI | 1083633390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MA 242754) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: NC 2007-01970) |
| 207L00000X Anesthesiology (Licence: NH 13050) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2024-11-01 |