| NPI | 1174586903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: FL ME79177) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OH 35067692P) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2014-09-09 |