| NPI | 1326039223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: SC 25109) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: NC 2006-01101) |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2024-02-09 |