| NPI | 1306893680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: FL ME68389) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: FL ME68389) |
| 207L00000X Anesthesiology (Licence: NY 197169) | |
| 207LP2900X Anesthesiology Pain Medicine (Licence: NY 197169) | |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2009-08-20 |