| NPI | 1306868245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: NY 237238) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX M4838) |
| Enumeration Date | 2006-07-23 |
| Last Update Date | 2012-12-10 |