| NPI | 1215318381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: AZ 010006) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: VA 0102205874) |
| 207L00000X Anesthesiology (Licence: MI 5101021595) | |
| 207LP2900X Anesthesiology Pain Medicine (Licence: TX S7332) | |
| Enumeration Date | 2015-06-15 |
| Last Update Date | 2022-10-26 |