| NPI | 1265482285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: GA 045782) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: GA 45782) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: GA 045782) | |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2019-07-16 |