| NPI | 1245488675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 2014-01769) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: SC 39232) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: PA OS015480) | |
| Enumeration Date | 2008-08-27 |
| Last Update Date | 2024-09-19 |