| NPI | 1083633390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MA 242754) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NH 13050) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: NC 2007-01970) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2012-01-24 |