| NPI | 1295916104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NC 201101565) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: NE 23423) |
| Enumeration Date | 2007-11-19 |
| Last Update Date | 2024-05-02 |