| NPI | 1114915477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: FL ME50622) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: FL ME0050622) |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2018-03-08 |