| NPI | 1124192943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: CO 25593) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: CO CDRH.0025593) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2024-09-24 |