| NPI | 1235363813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: GA 069609) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4301092442) |
| Enumeration Date | 2009-05-11 |
| Last Update Date | 2014-09-04 |