| NPI | 1164401980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AL 00014159) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: AL 00014159) |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2007-07-08 |