| NPI | 1245411024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: SC 33911) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: GA 201000443) |
| Enumeration Date | 2007-11-20 |
| Last Update Date | 2020-05-01 |