| NPI | 1316960065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: TX L5046) |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine (Licence: TX L5046) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2013-04-23 |