| NPI | 1215936208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: MI 4301075665) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 220270) |
| 207L00000X Anesthesiology (Licence: CT 73175) | |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2023-06-08 |