| NPI | 1255630927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 2016-00360) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA MD454188) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: NC 2016-00360) | |
| Enumeration Date | 2011-03-21 |
| Last Update Date | 2022-07-21 |