| NPI | 1235331422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: CA C156977) |
| Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care (Licence: FL ME98868) |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2023-06-29 |