| NPI | 1295826618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME89336) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MA 150667) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: VA 0101237040) | |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2010-10-05 |