| NPI | 1306814777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: OK 19113) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: OK 19113) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: OK 19113) | |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2014-03-14 |