| NPI | 1164414793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: TX H2060) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: TX H2060) |
| Enumeration Date | 2005-08-19 |
| Last Update Date | 2019-08-19 |