| NPI | 1316177751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: GA 072024) |
| Additional Taxonomies | 174400000X Specialist (Licence: GA 072024) |
| Enumeration Date | 2009-07-20 |
| Last Update Date | 2020-10-07 |