| NPI | 1255513214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 2023-02456) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: FL ME128770) |
| 207R00000X Internal Medicine (Licence: FL ME128770) | |
| Enumeration Date | 2007-12-03 |
| Last Update Date | 2024-09-19 |