| NPI | 1295700979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME153668) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NY 319929) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: IL 036108254) | |
| 207L00000X Anesthesiology (Licence: WI 2310) | |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2025-01-04 |