| NPI | 1255862777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: RI MD18602) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: MA 287693) |
| Enumeration Date | 2017-03-26 |
| Last Update Date | 2022-06-28 |