| NPI | 1083667083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: WA MD00035560) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: WA MD00035560) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2007-11-20 |