| NPI | 1255667812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: TX P8594) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 254788) |
| 207L00000X Anesthesiology (Licence: CA A114333) | |
| Enumeration Date | 2009-11-02 |
| Last Update Date | 2014-09-03 |