| NPI | 1306038674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: TX U0664) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: CT 49915) |
| 207L00000X Anesthesiology (Licence: PR 26467) | |
| Enumeration Date | 2007-08-10 |
| Last Update Date | 2024-04-05 |