| NPI | 1093169120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: TX T1392) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: TX T1392) |
| Enumeration Date | 2016-04-14 |
| Last Update Date | 2021-09-23 |