| NPI | 1215028204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: OK 25879) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: TX S3039) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2022-07-21 |