| NPI | 1114110608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: ID M-16016) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: UT 353884) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: CO 48797) | |
| Enumeration Date | 2007-08-20 |
| Last Update Date | 2021-11-23 |