| NPI | 1104829027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: TN 39029) |
| Additional Taxonomies | 174400000X Specialist (Licence: TN 39029) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2013-05-13 |