| NPI | 1245211911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: VA 0101265619) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: NC 02618) |
| 207L00000X Anesthesiology (Licence: AZ 25352) | |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2024-06-21 |