| NPI | 1225018971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: SC MD 23707) |
| Additional Taxonomies | 207LC0200X Anesthesiology, Critical Care Medicine (Licence: SC MD23707) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: SC MD 23707) | |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2009-01-08 |