| NPI | 1205430006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: MO R7N01) |
| Additional Taxonomies | 202C00000X Independent Medical Examiner (Licence: MO R7N01) |
| Enumeration Date | 2020-11-23 |
| Last Update Date | 2020-11-23 |