| NPI | 1093245722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: TN 66271) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: SC LL51274) |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2022-11-16 |