| NPI | 1144205899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AL 15383) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: AL 00015383) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: AL 15383) | |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2019-05-15 |