| NPI | 1225128093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LA0401X Anesthesiology, Addiction Medicine (Licence: OR MD23570) |
| Additional Taxonomies | 174400000X Specialist (Licence: OR MD23570) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2021-06-15 |