| NPI | 1134103534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MI 4301072727) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: MI 4301072727) |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2020-12-21 |