| NPI | 1316200538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: NM MD2024-0731) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: NM MD2024-0731) |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2024-09-20 |